IRCM researchers take an important step in making this promising
approach a reality

MONTREAL, Jan. 28, 2013 /CNW Telbec/ - IRCM researchers, led by
endocrinologist Dr. Rémi Rabasa-Lhoret, were the first to conduct a
trial comparing a dual-hormone artificial pancreas with conventional
diabetes treatment using an insulin pump and showed improved glucose
levels and lower risks of hypoglycemia. Their results, published today
in the Canadian Medical Association Journal (CMAJ), can have a great impact on the treatment of type 1 diabetes by
accelerating the development of the external artificial pancreas.

The artificial pancreas is an automated system that simulates the normal
pancreas by continuously adapting insulin delivery based on changes in
glucose levels. The dual-hormone artificial pancreas tested at the IRCM
controls glucose levels by automatically delivering insulin and
glucagon, if necessary, based on continuous glucose monitor (CGM)
readings and guided by an advanced algorithm.

"We found that the artificial pancreas improved glucose control by 15%
and significantly reduced the risk of hypoglycemia as compared with
conventional insulin pump therapy," explains engineer Ahmad Haidar,
first author of the study and doctoral student in Dr. Rabasa-Lhoret's
research unit at the IRCM and at the Department of Electrical and
Computer Engineering at McGill University. "The artificial pancreas
also resulted in an 8-fold reduction of the overall risk of
hypoglycemia, and a 20-fold reduction of the risk of nocturnal
hypoglycemia."

People living with type 1 diabetes must carefully manage their blood
glucose levels to ensure they remain within a target range. Blood
glucose control is the key to preventing serious long-term
complications related to high glucose levels (such as blindness or
kidney failure) and reduces the risk of hypoglycemia (dangerously low
blood glucose that can lead to confusion, disorientation and, if
severe, loss of consciousness).

"Approximately two-thirds of patients don't achieve their target range
with current treatments," says Dr. Rabasa-Lhoret, Director of the
Obesity, Metabolism and Diabetes research clinic at the IRCM. "The
artificial pancreas could help them reach these targets and reduce the
risk of hypoglycemia, which is feared by most patients and remains the
most common adverse effect of insulin therapy. In fact, nocturnal
hypoglycemia is the main barrier to reaching glycemic targets."

"Infusion pumps and glucose sensors are already commercially-available,
but patients must frequently check the sensor and adjust the pump's
output," says Mr. Haidar. "To liberate them from this sizable
challenge, we needed to find a way for the sensor to talk to the pump
directly. So we developed an intelligent dosing algorithm, which is the
brain of the system. It can constantly recalculate insulin dosing based
on changing glucose levels, in a similar way to the GPS system in a
car, which recalculates directions according to traffic or an itinerary
change."

The researchers' algorithm, which could eventually be integrated as
software into a smart phone, receives data from the CGM, calculates the
required insulin (and glucagon, if needed) and wirelessly controls the
pump to automatically administer the proper doses without intervention
by the patient.

"The system we tested more closely mimics a normal pancreas by secreting
both insulin and glucagon," adds Dr. Laurent Legault, peadiatric
endocrinologist and outgoing Director of the Insulin Pump Centre at the
Montreal Children's Hospital, and co-author of the study. "While
insulin lowers blood glucose levels, glucagon has the opposite effect
and raises glucose levels. Glucagon can protect against hypoglycemia if
a patient with diabetes miscalculates the necessary insulin dose."

"Our work is exciting because the artificial pancreas has the potential
to substantially improve the management of diabetes and reduce daily
frustrations for patients," concludes Dr. Rabasa-Lhoret. "We are
pursuing our clinical trials to test the system for longer periods and
with different age groups. It will then probably be introduced
gradually to clinical practice, using insulin alone, with early
generations focusing on overnight glucose controls."

About the study
This study was conducted with 15 adult patients with type 1 diabetes,
who had been using an insulin pump for at least three months. Patients
were admitted twice to the IRCM's clinical research facility and
received, in random order, both treatments: the dual-hormone artificial
pancreas and the conventional insulin pump therapy. During each 15-hour
visit, their blood glucose levels were monitored as they exercised on a
stationary bike, received an evening meal and a bedtime snack, and
slept at the facility overnight.

Dr. Rabasa-Lhoret's research is funded by Diabetes Québec, the Canadian
Diabetes Association, and the IRCM's J.A. De Sève Chair in clinical
research. IRCM collaborators who contributed to study published in CMAJ include Maryse Dallaire, Ammar Alkhateeb, Adèle Coriati, Virginie
Messier and Maude Millette. For more information on the study, please
refer to the article summary published online by CMAJ: http://www.cmaj.ca/content/early/2013/01/28/cmaj.121265.abstract.

About diabetes
Type-1 diabetes is a chronic, incurable disease that occurs when the
body doesn't produce enough or any insulin, leading to an excess of
sugar in the blood. It occurs most often in children, adolescents or
young adults. People with type-1 diabetes depend on insulin to live,
either through daily injections or with a pump. Diabetes is a major
cause of vision loss, kidney and cardiovascular diseases.

According to the Canadian Diabetes Association, an estimated 285 million
people worldwide are affected by diabetes, approximately 10 per cent of
which have type 1 diabetes. With a further 7 million people developing
diabetes each year, this number is expected to hit 438 million by 2030,
making it a global epidemic. Today, more than 9 million Canadians live
with diabetes or prediabetes.

About Dr. Rémi Rabasa-Lhoret
Dr. Rémi Rabasa-Lhoret completed his doctoral degree (MD) with a
specialization in endocrinology, metabolism and nutrition at the
Université Montpellier in France. He then obtained a PhD in food
sciences, and completed a postdoctoral fellowship in physiology and
molecular biology. At the IRCM, Dr. Rabasa-Lhoret is Director of the
Metabolic Diseases research unit, Director of the Diabetes, Metabolism
and Obesity clinic, and Director of the research platform on obesity,
metabolism and diabetes. He is an associate professor in the Department
of Nutrition at the Université de Montréal. He is also adjunct
professor in the Department of Medicine (Division of Experimental
Medicine) at McGill University. Dr. Rabasa-Lhoret is a Clinical
Research Scholar from the Fonds de recherche du Québec - Santé and
holds the J.A. DeSève Chair in clinical research. For more information,
visit www.ircm.qc.ca/rabasa.

About the IRCM
Founded in 1967, the IRCM (www.ircm.qc.ca) is currently comprised of 37 research units in various fields, namely
immunity and viral infections, cardiovascular and metabolic diseases,
cancer, neurobiology and development, systems biology and medicinal
chemistry. It also houses three specialized research clinics, eight
core facilities and three research platforms with state-of-the-art
equipment. The IRCM employs 425 people and is an independent
institution affiliated with the Université de Montréal. The IRCM Clinic
is associated to the Centre hospitalier de l'Université de Montréal
(CHUM). The IRCM also maintains a long-standing association with McGill
University.